AB1131 IDENTIFICATION OF FACTORS ASSOCIATED WITH THE OCCURRENCE OF SEVERE FORMS OF COVID-19 INFECTION IN PATIENTS WITH AUTOIMMUNE/INFLAMMATORY RHEUMATIC DISEASES
Authors: K. Chevalier, M. Genin, T. Petit Jean, J. Avouac, R. M. Flipo, S. Georgin-Lavialle, S. El Mahou, E. Pertuiset, T. Pham, A. Servettaz, H. Marotte, F. Domont, P. Chazerain, M. Devaux, A. Mekinian, J. Sellam, B. Fautrel, D. Rouzaud, E. Ebstein, N. Costedoat-Chalumeau, C. Richez, E. Hachulla, X. Mariette, R. Seror
Journal: Annals of the Rheumatic Diseases (2022)

Background Patients with autoimmune/inflammatory rheumatic diseases (AIRD) were suspected to be an at-risk population of severe COVID-19. However, whether this higher risk is linked to the disease or to its treatment is difficult to determine. Objectives To identify, among AIRD patients, factors associated with occurrence of moderate-to-severe COVID19 infection and to evaluate if having an AIRD was associated with an increased risk of severe form of COVID19 infection (defined by hospitalization in ICU or death), compared to general population. Methods Data source: The “Entrepôt des Données de Santé (EDS)” collect data from electronic health records of all patients hospitalized or followed in the AP-HP (39 hospitals in Paris area, France). The French RMD COVID19 cohort is a national multi-center cohort that included patients with confirmed AIRD and diagnosed with COVID-19. All AIRD patients diagnosed with COVID-19 before September 2020 from both cohorts were included. -We Identified factors associated with severe COVID-19 was made in a combined analysis of the 2 cohorts. -Then, we compared COVID-19 infection severity in the EDS-COVID database in AIRD patients and controls, by a propensity score (PS)-matched case-control (1:4) study Results Among 1213 patients (334 in EDS and 879 in RMD cohort), 195 (16.1%) experienced a severe COVID19. In multivariate analysis, greater age, history of interstitial lung disease, arterial hypertension, obesity, sarcoidosis, vasculitis, auto-inflammatory disease and treatment with corticosteroids or rituximab were associated with severe COVID-19 (Table 1). Table 1. AIRD patient’s characteristics associated with severity of COVID-19 Patients with mild or moderate infection Patients with severe infection OR ajustés 95%CI p-value (N = 1018 ) (N = 195 ) Patients characteristics Age 55.9 (16.7%) 70.3 (14.3%) 1.05 [1.03;1.07] &lt;0.001 Gender: Female 695 (68.3%) 105 (54.1%) 0.59 [0.38;0.94] 0.025 Interstitial pneumonia 38 (3.7%) 20 (10.3%) 2.94 [1.34;6.34] 0.008 Obesity 143 (17.8%) 38 (27.7%) 2.09 [1.26;3.43] 0.004 Hypertension 268 (26.3%) 114 (58.5%) 1.81 [1.13;2.89] 0.013 Underlying Disease: Chronic inflammatory arthritis 618 (60.8%) 72 (36.9%) Ref. Auto-inflammatory disease 29 (2.9%) 5 (2.6%) 3.91 [1.2;11.32] 0.025 Other 29 (2.9%) 4 (2.1%) 0.35 [0.06;1.41] 0.15 Connectivitis 190 (18.7%) 34 (17.4%) 1.13 [0.62;2.01] 0.69 Sarcoidosis 40 (3.9%) 24 (12.3%) 5.19 [2.15;12.3] &lt;0.001 Vasculitis 111 (10.9%) 56 (28.7%) 1.8 [1.02;3.16] 0.044 Treatments Corticosteroid 318 (31.2%) 117 (60.0%) 2.47 [1.58;3.87] &lt;0.001 Leflunomide 44 (4.3%) 2 (1.0%) 0.13 [0;0.97] 0.045 Rituximab 37 (3.7%) 22 (11.5%) 4.05 [1.96;8.27] &lt;0.001 Not significant in multivariate analysis COPD, Asthma, Coronary heart diseases, stroke, diabetes, smoking, cancer, non-steroidal anti-inflammatory drugs, colchicine, hydroxychloroquine, methotrexate, salazopyrine, mycophenolate mofetil, azathioprine, intravenous immunoglobulins, anti-TNFα, anti-IL1, -IL6, -IL17, Abatacept, JAK inhibitor Among 35741 COVID-19 patients in EDS, 316 with AIRD were compared to 1264 PS-matched controls. Severe form occurred in 118 (37,3%) AIRD cases and 384 (30.4%) controls (Adjusted OR (aOR) for severe form= 1.43 [1.1;1.9], p=0,01). In analysis restricted to rheumatoid arthritis (RA) and spondylarthritis (SpA), no increased risk of severe form (aOR=1.11 [0.68;1.81]) form or death (aOR=1.00 [0.55;1.81]) was observed. Conclusion In this multicenter study we confirmed that AIRD patients treated with rituximab or corticosteroids were at increased risk of severe COVID-19, as were those with vasculitis, auto-inflammatory disease, and sarcoidosis. Also, when compared to controls from the same cohort of hospitalized patients, AIRD patients had, overall, an increased risk of severe COVID-19, increased risk not observed in an analysis restricted to patients with RA or SpA. Acknowledgements FAI2R /SFR/SNFMI/SOFREMIP/CRI/IMIDIATE consortium and contributors Patricia Martel All clinicians/physicians implicated in COVID-19 patient care in APHP hospital and generated EDS patient data Disclosure of Interests None declared